도시.농어촌 복합형 u-헬스케어 시스템 구축 사업 이용행태 분석

신은규,Shine, Eun-Kyu 한국정보통신학회 2011 한국정보통신학회지 Vol.12 No.1

건강보험 위험요인 평가모형 비교 연구

신은규(Shine, Eun-Kyu),정기택(Jung, Kee-Taig) 대한경영학회 2013 대한경영학회 학술발표대회 발표논문집 Vol.2013 No.2

본 연구에서는 보험가입자 개인의 건강위험 요인이 가지고 있는 특성을 파악하여 위험을 균등화함으로써 얻어지는 건강보험 시장의 효용을 기반으로 동일한 건강보험상품을 제공하는 건강보험회사의 가입자 즉, 피보험자의 건강상태에 따른 재정적 위험을 해소하기 위한 보험자의 가입자 선택 인센티브는 항상 시장에서 존재한다. 이러한 보험자의 가입자 선택 인센티브는 건강보험시장의 효율성 측면에서 많은 문제점을 야기하고 있다. 따라서, 건강보험의 효율성 인센티브 즉, 전체 건강보험시장이 가입자 선택보다 운영의 효율성이 증가하도록 하기 위해서는 건강보험 가입자의 건강상태에 대한 위험요인이 적정하게 평가되도록 하는 방안을 통해 보험자의 위험율을 감소시키면서 정확한 보험료 산정에 기여하도록 해야 하는 필요성이 존재한다. 본 연구는 이러한 위험요인을 평가하는 모형을 비교하여 분석하였으며 분석 결과, 의료이용에 있어 여성보다는 남성이, 연령은 높을수록 전체진료비용이 높은 (+)의 상관관계를 갖고 있었다. 본 연구는 건강보험시장의 효율화를 통해 다수의 보험자가 경쟁에 참여하게 되는 체계를 전제로 위험요인 평가모형의 설명력을 측정하여 상호비교한 것이다. 이러한 설명력을 측정하기 위해 민영건강보험의 실손형 보험상품에 가입한 사람들이 각 개별보험사에 청구한 청구자료와 민간보험사의 전산자료를 통합하여 활용하였다. 즉, 현재 우리나라의 건강보험시장에서 보험가입자 개인 수준의 건강보험 손해율에 영향을 미치는 요인들을 분석하였다. 본 연구결과에서 국내의 민영건강보험사들은 보험자의 가입자 선택이 상당히 높은 것으로 조사되었다. 이는 보험시장에서 건강보험이라는 영역에 국민건강보험이 전체 의료시스템을 관리하게 되면서 민영건강보험사들은 보충적 성격의 의료보장을 제한적으로 하게 된 이유에서 비롯된 것으로 보인다. 국민 전체를 보장하지 않고 제한된 가입자를 갖게 되는 민영건강보험사들의 입장에서는 고위험군보다 저위험군에 대한 보장이 용이하기 때문이다. 그러나, 이러한 시장환경에서 민영건강보험의 시장규모가 놀랍게 성장한 지금은 보충적 성격을 넘어 암 등 고액진료에 있어 없어서는 안 될 존재로 등장하고 있다. 더욱이 국민건강보험의 비효율적인 관리운영 문제는 단일 독점적 보험자로서 건강보험 영역을 지배하고 있어 보험자간의 경쟁이 없도록 하는 제한을 시장에 남기고 있다. 이러한 시점에 최근 일부에서는 국민건강보험의 기금화 전환에 대한 의견이 제시되고 있으며 이러한 움직임을 통해 기금전환에 대한 방법론으로 어떻게 하면 보험가입자 개인이 가지고 있는 건강위험요인의 불확실성 혹은 위험을 균등화시킬 것이냐에 대한 논의가 진행되고 있다. 특히, 본 연구에서 실증분석의 결과로 제시된 건강영향요인에 대한 분석은 향후 우리나라의 건강보험 시장에서 보험자의 가입자선택 인센티브를 감소시키고 보험자로 하여금 진료비 절감을 위한 효율성에 대한 인센티브를 부여하기 때문에 건강보험시장에서 소비자의 효용을 높일 수 있을 것으로 판단된다. 특히, 경쟁을 도입함에 있어 시장점유율과 판매조직의 우위 등 기존 경쟁방식과 달리 소규모 보험자의 입장에서도 건강영향요인에 대한 분석을 통해 동일한 경쟁조건을 보장받음으로써 보험자는 진료비절감과 효율적인 보장을 위한 인센티브 제고가 크게 이루어질 것으로 기대된다. 따라서 향후 건강보험 개혁에 대한 정책적 논의에서 건강영향요인에 대한 분석은 반드시 고려되어야 할 것이며 국민의 건강상태를 충족시키기 위한 UN의 권고사항 중 효율성과 반응성, 형평성 등을 모두 건강영향요인에 대한 분석에 집중시켜야 할 것이다. The purpose of this study is for analyzing utilization of each individual insurer at health care insurance market through risk adjustment for expenditure spending risk of the people. This study considered cases of netherlands about Risk Equalization to help understanding of risk equalization introduction. To know what is the closest correlation between variables for estimating expenditure spending risk and healthcare expenditure, this study analyzed data of indemnity private health care insurance. The result of this study presents that risk adjustment leads to competition by consumer"s choice at the healthcare insurance market in spite of using of some variables restrictively. At the same time, this revealed that every utilization of Insurers about risk factors is different in the case of considering reality that insurers feel more delicately than government or central agency operating risk equalization fund in the whole health care insurance system. This study suggest that risk evaluation model introduction could bring every insurer utilization of incentives"s deduction for selection is high and efficient incentives for expenditure saving is low on the competitive health care insurance market. Therefore, this study is valuable that risk evaluation model is analyzed in Korea before enrolling risk equalization policy, and expectable to do an important role of health care reform process.

한국 건강보험시장의 위험균등화를 통한 시장효율화 방안 연구

신은규(Eun-Kyu, Shine) 대한경영학회 2013 대한경영학회 학술발표대회 발표논문집 Vol.2013 No.1

연구 에서는 보험 가입자 개인의 건강위험 요인이 가지고 있는 특성을 파악하여 위험을 균등화함으로써 얻어지는 건강보험 시장의 효용을 첫 번째로 보험자의 가입자 선택 인센티브의 감소로 파악하였다. 두 번째는 건강보험의 효율성 인센티브 즉, 적정 진료비를 유지함으로써 증가하는 전체 시장의 효율성으로 파악하였다. 연구결과, 의료이용에 있어 여성보다는 남성이, 연령은 높을 수록 전체진료비용이 높은(+)의 상관관계를 갖고 있었다. 한편 , 민영건강보험사들은 공적건강보험 즉, 정부나 중앙기금 운영자보다 위험이 낮은 가입자를 선호하거나, 고위험군을 회피하려는 가입자 선택에 대한 유인이 존재하므로 인구통계적 모형과 함께 보험자들의 의료이용정보를 활용한 선택모형을 동시에 사용하게 되었다. 이에 본 연구 에서는 선택 모형에 추가 적으로 입원기간과 통원기간을 반영하였고 그 결과 , 입원기간이 길수록 전체진료비용은 증가하는(+)의 상관관계가 통계적으로 유의하게 도출되었다. 또한, 인구통계모형의 진료비에 대한 설명력(R²)이 0.0 27을 나타내는 것에 비해 선택모형은 설명력(R²)이 0.1 64로 높아졌다. 이에 따라 각 개별보험자는 정부나 중앙기금이 반영하지 못하는 가입자의 위험을 반영하여 가입자 선택에 대한 인센 티브를 갖게 되는 것으로 나타났다. 본 연구의 실증분석 결과에 따르면 우리나라 민영건강보험사들은 가입자 선택 인센티브 감소 효용이 큰 것으로 나타났다. 즉, 현재 시점에서 보험자는 가입자 선택에 의해 보험자의 지불능력을 확보하는 것으로 파악되었다. 가입자와의 계약 이후 진료비절감을 위한 노력보다는 보험자 입장에서 가입자선택에 의해 보험사의 위험을 줄이는 것이 손쉬운 운영방안이기 때문이다. 이는 기왕증을 가지고 있거나 위험한 직업군에 종사하는 사람들에게 발생하게 될 의료비용의 보장이 제한적으로 이루어지게 되는 요인이 되고 있다. 따라서 본 연구결과를 통해 보험자들의 가입자선택 방지와 보험자들의 경쟁을 통한 보험자 내부의 효율성 제고가 필요하며 이를 위해 위험균등화를 도입함으로써 각 효용간의 적정한 가중치가 형성되도록 할 필요가 있다는 시사점을 제시 하고 있다. The purpose of this study is for analyzing utilization of each individual insurer at health care insurance market through risk equalization for expenditure spending risk of the people. This study considered cases of netherlands about Risk Equalization to help understanding of risk equalization introduction. To know what is the closest correlation between variables for estimating expenditure spending risk and healthcare expenditure, this study analyzed data of indemnity private health care insurance. The result of this study presents that risk equalization leads to competition by consumer"s choice at the healthcare insurance market in spite of using of some variables restrictively. At the same time, this revealed that every utilization of Insurers about risk equalization is different in the case of considering reality that insurers feel more delicately than government or central agency operating risk equalization fund in the whole health care insurance system. This study suggest that risk equalization introduction could bring every insurer utilization of incentives"s deduction for selection is high and efficient incentives for expenditure saving is low on the competitive health care insurance market. Therefore, this study is valuable that risk equalization is analyzed in Korea for the first time before enrolling risk equalization policy, and expectable to do an important role of health care reform process.

청구 자료를 활용한 A보험사의 건강보험상품 위험요인 비교 연구

신은규 ( Eun Kyu Shine ),정기택 ( Ki Taig Jung ) 경희대학교 경영연구원 2013 의료경영학연구 Vol.7 No.4

The purpose of this study is for analyzing utilization of each individual insurer at health care insurance market through risk equalization for expenditure spending risk of the people. This study considered cases of netherlands about Risk Equalization to help understanding of risk equalization introduction. To know what is the closest correlation between variables for estimating expenditure spending risk and healthcare expenditure, this study analyzed data of indemnity private health care insurance. The result of this study presents that every utilization of Insurer about risk equalization is different in the case of considering reality that insurers feel more delicately than government or central agency operating risk equalization fund in the whole health care insurance system. This study suggest that risk equalization introduction could bring every insurer utilization of incentives`s deduction for selection is high and efficient incentives for expenditure saving is low on the competitive health care insurance market. Therefore, this study is valuable that risk equalization is analyzed in Korea for the first time before enrolling risk equalization policy, and expectable to do an important role of health care reform process.

AHP를 이용한 부산지역 네트워크 치과 의원의 브랜드 이미지 선호요인에 관한 연구

신은규 ( Eun Kyu Shine ) 경희대학교 경영연구원 2011 의료경영학연구 Vol.5 No.1

It is now more important for hospitals to build the image of hospital Brand. Many of clinics are trying to association with other clinics, then clinic network is seem to be spread quickly in recent 7 years, especially in dental clinics. In this study, we examined two issues. First, we researched relative priorities of preference that every network clinic has and their global weights using by AHP. Secondary, we also evaluated characteristics of elements of brand preference that each network dental clinic has. We choose three dental clinics of Busan area-Ye, Moa, Mir among all dental networks, these are older and larger numbers than others. To evaluate relative priority, we devised the model using the AHP and we assured the validation. we constructed the evaluation model that identified its evaluation factors of brand images by Keller(1993). We derived the relative weights and priorities of 9 evaluation factors using the AHP, which is a useful tool to quantify the subjective judgements rationally. Then we got the results, experience is the most important then function is next, credibity, price, market leader, reputation, expert opinion, and trademark is the least important. It is same results by constant sum scale. The characteristics of elements of brand preference that each three network dental clinic has are not significant. It is because network brand is not familiar to medical consumers. Nevertheless most of them responded they would visit network dental clinics next time so they prefer network rather than non-network dental clinics.

AHP를 이용한 의료관광 대상국가의 국가 이미지 선호 및 평가요인별 중요도에 관한 연구 -인도네시아의 잠재적 환자를 대상으로-

신은규 ( Eun Kyu Shine ) 경희대학교 경영연구원 2015 의료경영학연구 Vol.9 No.4

In the case of Korean medical tourism industry, elective procedures such as cosmetic surgery, aesthetic or medical check-up are in high-demand rather than necessary main surgery such as cardiac stenosis surgery, so the domestic clinics`` take a big role in Korean medical tourism industry. This study focuses on the relationship between the South Korea``s state image and quality of medical tourism service, and how medical tourism affects on Indonesia potential customers. Medical service refers to as a special service. It is a process and system of diagnosis and treatment behaviors of experts, who received specialized high education and got certain qualification or license. Also, as same as general service, it has characteristics of intangibility, non separability, variability, and perishability. Medical tourism is away of attracting overseas patients, together with medical services and recreation, leisure, cultural activities such as tourism activities in combination with the meaning of a new tourism form, and in the same way as medical industry and the tourism industry of integration, points out the features. To evaluate relative priority, we devised the model using the AHP and we assured the validation. we constructed the evaluation model that identified its evaluation factors of brand images by Keller(1993). We derived the relative weights and priorities of 9 evaluation factors using the AHP, which is a useful tool to quantify the subjective judgements rationally. Then we got the results, experience is the most important then function is next, credibity, price, market leader, reputation, expert opinion, and trademark is the least important. It is same results by constant sum scale. The characteristics of elements of state image preference that each medical tourism state has are not significant. It is because medical tourism state is not familiar to medical consumers. Nevertheless most of them responded they would visit some states next time so they prefer states rather than non-medical tourism oriented states.

해외환자유치 전담인력과 리더의 관계증진이 조직적응력 및 업무성과에 미치는 영향에 관한 연구 -부산지역 의원급 의료기관을 중심으로-

신은규 ( Eun Kyu Shine ) 경희대학교 경영연구원 2012 의료경영학연구 Vol.6 No.3

This research is conducted to understand LMX on Job Attitude of Attracting Foreign Patients Facultis of Busan domestic clinics` activities to attract foreign patients which somehow neglected from social issues even though it takes a significant part of Medical Industry in Korea. In the case of Korean medical tourism industry, from this study, we intended to find the causal relationship among LMX, job satisfaction, organizational commitment, and organizational citizenship behavior in foreign patients organizational unit of Busan province hospital. Practical implications according to result of this study are as follows. First, activities for promotion of relationship between higher officer who are medical doctors and follower who are foreign patients faculties can efficiently improve organizational effect such as job satisfaction, organizational citizen behavior in organization of hospital. Second, style of organizational commitment of foreign patients organization turned out sustainable commitment. Third, especially, LMX did directly have influence on organizational commitment, also indirectly have influence on it via job satisfaction. It shows that job satisfaction of foreign patients organization in hospital comes from LMX, it also have effect on sustainable organizational commitment. In a word, LMX is very important issue in foreign patients faculties and organization of hospital. Therefore, this research strive to identify the state of clinics` promotion activities which for attracting foreign patients and reveal the challenges for them.

해외환자 유치인력과 의료진의 관계증진이 업무성과에 미치는 영향에 관한 연구

신은규(Eun-Kyu, Shine) 대한경영학회 2012 대한경영학회 학술발표대회 발표논문집 Vol.2012 No.1

This research is conducted to understand LMX on Job Attitude of Attracting Foreign Patients Facultis of Busan domestic clinics" activities to attract foreign patients which somehow neglected from social issues even though it takes a significant part of Medical Industry in Korea. In the case of Korean medical tourism industry, from this study, we intended to find the causal relationship among LMX, job satisfaction, organizational commitment, and organizational citizenship behavior in foreign patients organizational unit of Busan province hospital. Practical implications according to result of this study are as follows. First, activities for promotion of relationship between higher officer who are medical doctors and follower who are foreign patients faculties can efficiently improve organizational effect such as job satisfaction, organizational citizen behavior in organization of hospital. Second, style of organizational commitment of foreign patients organization turned out sustainable commitment. Third, especially, LMX did directly have influence on organizational commitment, also indirectly have influence on it via job satisfaction. It shows that job satisfaction of foreign patients organization in hospital comes from LMX, it also have effect on sustainable organizational commitment. In a word, LMX is very important issue in foreign patients faculties and organization of hospital. Therefore, this research strive to identify the state of clinics" promotion activities which for attracting foreign patients and reveal the challenges for them.

위험균등화(Risk Equalization) 도입을 위한 건강보험 위험요인 평가모형 비교 연구

신은규 ( Eun Kyu Shine ),정기택 ( Kee Taig Jung ) 경희대학교 경영연구원 2013 의료경영학연구 Vol.7 No.2

The purpose of this study is for analyzing utilization of each individual insurer at health care insurance market through risk adjustment for expenditure spending risk of the people. This study considered cases of netherlands about Risk Equalization to help understanding of risk equalization introduction. To know what is the closest correlation between variables for estimating expenditure spending risk and healthcare expenditure, this study analyzed data of indemnity private health care insurance. The result of this study presents that risk adjustment leads to competition by consumer`s choice at the healthcare insurance market in spite of using of some variables restrictively. At the same time, this revealed that every utilization of Insurers about risk factors is different in the case of considering reality that insurers feel more delicately than government or central agency operating risk equalization fund in the whole health care insurance system. This study suggest that risk evaluation model introduction could bring every insurer utilization of incentives`s deduction for selection is high and efficient incentives for expenditure saving is low on the competitive health care insurance market. Therefore, this study is valuable that risk evaluation model is analyzed in Korea before enrolling risk equalization policy, and expectable to do an important role of health care reform process.

A사의 민영건강보험 청구 자료에 근거한 건강위험요인(비급여항목) 분석

신은규(Eun-Kyu Shine) 대한경영학회 2014 대한경영학회 학술발표대회 발표논문집 Vol.2014 No.2